Implementation of a cauda equina service in a medium-sized district general hospital in the UK
Selina Graham1, Pradeep Madhavan1,
1Spinal Surgery Service, Department of Orthopaedics and Trauma, Somerset Foundation Trust, Musgrove Park Hospital, Taunton, Somerset, UK, on behalf of the Cauda Equina Syndrome Study Group (CESSG) at Somerset Foundation Trust Members of the Cauda Equina Syndrome Study Group at Somerset Foundation Trust: Selina Graham, Pradeep Madhavan, Paul Thorpe, Yee Leung, Ashok Subramanian, Dushan Thavarajah, Paul Burn, Danial Fox, Guru Karnati, Iain Palmer on behalf of the Cauda Equina Syndrome Study Group at Somerset Foundation Trust.
Aim:
This project explored how the implementation of national guidance for investigation and management of patients with suspected cauda equina syndrome impacted on service provision.
Methods:
Retrospective analysis of patients with suspected cauda equina syndrome during 12 months before the implementation of the national guidelines were compared with data from the 21 months following.
Results:
Monthly mean numbers of referrals for suspected cauda equina syndrome increased from 10.1 to 18.9 (P<0.001). Statistically significant increases were also seen in the total number of magnetic resonance imaging scans for suspected cauda equina syndrome, and the number of magnetic resonance imaging scans performed out of hours. The mean time interval, from magnetic resonance imaging scan confirming cauda equina syndrome to starting emergency decompressive surgery, reduced from 14.87 hours to 9.57 hours.
Conclusions:
Compliance with the national guidance for suspected cauda equina syndrome is imperative for patients to receive optimal treatment. However, this project has demonstrated challenges related to increased pressure on resources.
